Presentation on definition and general overview of COPD, how to differentiate COPD from Asthma, how to make diagnosis of COPD, simple tools for assessment of COPD; available therapeutic options; as well as management of stable COPD, COPD exacerbations and comorbidities
chronic obstructive pulmonary disease and its management
chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease.
chronic obstructive pulmonary disease and its management
chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs.
COPD typically has a clear cause and a clear path of prevention, and there are ways to slow the progression of the disease.
Interstitial Lung Diseases [ILD] Approach to ManagementArun Vasireddy
Diffuse (interstitial) lung disease includes a wide variety of relatively uncommon conditions presenting with characteristic clusters of clinical features and marked by an immune response. There are over 200 specific diffuse lung diseases, many of unknown etiology. The combined incidence is 50 per 100,000, or 1 in 2000 people. Because these conditions cause aberrant lung function, morbidity and mortality due to lung injury and fibrosis are not uncommon. Both environmental and genetic factors are believed to contribute to the development of diffuse lung disease. Antigen processing and presentation are important in the development of the immune response seen in the disease, and it is thought that the likely candidate genes predisposing patients to this category of disease are those of the major histocompatibility complex. Genes that affect the immune, inflammatory, and fibrotic processes may also influence who develops the disease. If we can identify the genes that cause diseases characterized by lung injury and fibrosis, we can eventually develop genetic interventional approaches to treatment.
COPD, EMPHYSEMA, CHRONIC BRONCHITIS,LUNG DISEASE, OBSTRUCTIVE LING DISEASE, PHYSIOLOGY, KINGS COLLEGE,DPT DEPARTMENT ALL necessary information regarding lung disease which you should know
Asbestos-related diseases include non-malignant disorders such as asbestosis, diffuse pleural thickening, pleural plaques, pleural effusion, rounded atelectasis and malignancies such as lung cancer and malignant mesothelioma.
Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs' anatomic structure.
Some of the types of interstitial lung disease include:
Interstitial pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.
Idiopathic pulmonary fibrosis : A chronic, progressive form of fibrosis (scarring) of the interstitium. Its cause is unknown.
Nonspecific interstitial pneumonitis: Interstitial lung disease that's often present with autoimmune conditions (such as rheumatoid arthritis or scleroderma).
Interstitial Lung Diseases [ILD] Approach to ManagementArun Vasireddy
Diffuse (interstitial) lung disease includes a wide variety of relatively uncommon conditions presenting with characteristic clusters of clinical features and marked by an immune response. There are over 200 specific diffuse lung diseases, many of unknown etiology. The combined incidence is 50 per 100,000, or 1 in 2000 people. Because these conditions cause aberrant lung function, morbidity and mortality due to lung injury and fibrosis are not uncommon. Both environmental and genetic factors are believed to contribute to the development of diffuse lung disease. Antigen processing and presentation are important in the development of the immune response seen in the disease, and it is thought that the likely candidate genes predisposing patients to this category of disease are those of the major histocompatibility complex. Genes that affect the immune, inflammatory, and fibrotic processes may also influence who develops the disease. If we can identify the genes that cause diseases characterized by lung injury and fibrosis, we can eventually develop genetic interventional approaches to treatment.
COPD, EMPHYSEMA, CHRONIC BRONCHITIS,LUNG DISEASE, OBSTRUCTIVE LING DISEASE, PHYSIOLOGY, KINGS COLLEGE,DPT DEPARTMENT ALL necessary information regarding lung disease which you should know
Asbestos-related diseases include non-malignant disorders such as asbestosis, diffuse pleural thickening, pleural plaques, pleural effusion, rounded atelectasis and malignancies such as lung cancer and malignant mesothelioma.
Interstitial lung disease is a general category that includes many different lung conditions. All interstitial lung diseases affect the interstitium, a part of the lungs' anatomic structure.
Some of the types of interstitial lung disease include:
Interstitial pneumonia: Bacteria, viruses, or fungi may infect the interstitium of the lung. A bacterium called Mycoplasma pneumonia is the most common cause.
Idiopathic pulmonary fibrosis : A chronic, progressive form of fibrosis (scarring) of the interstitium. Its cause is unknown.
Nonspecific interstitial pneumonitis: Interstitial lung disease that's often present with autoimmune conditions (such as rheumatoid arthritis or scleroderma).
These slides offer a comprehensive overview of Chronic Obstructive Pulmonary Disease (COPD), a progressive lung disorder characterized by airflow limitation and persistent respiratory symptoms. Delve into the pathophysiology of COPD, understanding the role of smoking, environmental factors, and genetic predisposition in its development. Learn about the clinical manifestations, including chronic bronchitis and emphysema, and how they contribute to the disease's progression. The presentation explores diagnostic methods such as spirometry and imaging techniques, as well as the GOLD guidelines that aid in disease staging and management. Discover the multifaceted treatment approaches, including bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, and lifestyle modifications. These slides provide a comprehensive resource for grasping the complexities of COPD and its management.
Define and understand the types of advanced lung disease (ALD)
Discuss the impact of ALD on patients, family, and the health system
Describe the symptom burden of ALD
Appreciate factors associated with a poorer prognosis in ALD
Identify guidelines for referral to Hospice
Review the medical management of ALD
Patient safety Incident (PSI) is an unplanned or unintended event or circumstance that could have resulted or did result in harm to a patient while in the care of a health facility. In this presentation, I explored the concepts of patient safety and patient safety incidents. I also explored the concept of Reporting systems, properly now known as reporting and learning systems - because learning is paramount in the reporting system. I focused on the minimal information model, which is more routinely used compared to the intermediate and full information models.
It is unacceptable that there is still a lot of new HIV infections, particularly when there is a known high-risk exposure to the disease. It is important to know that Post-exposure prophylaxis is a medical emergency, and as part of effort to reduce the burden of HIV, post-exposure prophylaxis has been found to be effective when done appropriately. This presentation explores the concept of post-exposure prophylaxis for HIV and the latest changes in the guidelines.
“Undetectable = Untransmittable” (U=U) is a campaign that has caused a few controversies, not to mention the medicolegal implications. This campaign confirms that the sexual transmission of HIV can be stopped once the infected partner is virologically suppressed. How true is this and how relevant is it? In this presentation, I discussed the concept of U=U as one of the measures to reduce the incidence of HIV and help people live a more fulfilling life while also living with the disease.
TB remains an important disease condition globally, particularly with the high prevalence of HIV in many parts of the world. While there is interest in providing the adequate and often readily-available treatment, it might do more harm to the patient. In this presentation, I explored the concept of IRIS in the management of tuberculosis.
Experiencing any type of bleeding can be uncomfortable and frightening for patients, and it is one of the primary reasons they seek medical attention. In this case presentation, I will discuss some crucial approaches to patients who present with lower gastrointestinal bleeding, as well as some key take-home messages.
Headache is a common condition encountered by clinicians in general practice and primary care on a daily basis. Although most headaches are mild, some can be severe and debilitating. It is therefore crucial to recognize common symptoms, identify warning signs, and develop an appropriate management plan for headaches.
This is a presentation about the importance of Evidence Based Medicine and how it acts as a crucial tool in decision making to empower the quality of medical services for better patient outcomes.
It highlights the steps in EBM process, how to identify the parts of a well built clinical question, resources for literature search, critical appraisal of the evidence, and how to apply the evidence to the patient.
Infection Prevention and Control in Hospitals by Dr DeleKemi Dele-Ijagbulu
Infection prevention and control is everybody's business! It is an essential, though often under-recognised and under supported part of the infrastructure of health care. However it saves lives and prevents avoidable morbidity and mortality. This presentation highlights the importance and the practical components of infection prevention and control in the hospital setting.
This presentation on renal function touches on basic anatomy and physiology, investigations relevant to kidney function and clinical practice, and focuses on clinically important disorders - including glomerular diseases - nephrotic syndrome & Glomerulonephritides, acute kidney injury, Chronic kidney disease, HIV and CKD including HIVAN, and renal calculi
Tuberculosis is a chronic, wasting, communicable disease, which made a huge comeback with the HIV pandemic, making it an opportunistic infection, and and an AID-defining infection. This presentation explores the different types of tuberculosis in terms of their locations (pulmonary and extra-pulmonary) as well as in terms of their drug susceptibility. It also addresses the approach to the management of each one of these.
In the early days of the COVID pandemic, the World Tuberculosis Day was marked, with the Theme: "It is Time". It is time to take action, to ensure universal access to treatment, to stop stigma and discrimination, and to end TB.
I had the opportunity to present this topic as part of the wellness efforts for our staff members. Many of our patients live with TB, many of our staff develop TB in the process, and the COVID pandemic was already in the country, complication case identification and case management of the disease.
This presentation touches briefly on the vaginal discharges, both physiological and pathological, approach to management, and a brief touch on pelvic inflammatory disease.
Abortion remains a topical issue, globally, primary because it affects one of the fundamental rights. This presentation is not for debate, but simply highlights the South African laws and regulations as they relate to Termination of Pregnancy (TOP), and the different methods available.
This presentation focuses on the all important topic of childhood malnutrition. It addresses the different components, both acute and chronic, but focuses more on the severe acute malnutrition which is the most important killer, particularly for the under-5s.
terms like kwashiokor and marasmus are no longer in use.
This presentation focuses on the entity known as pyrexia of unknown origin / fever of unknown origin. It demonstrates both common and rare causes, and the epidemiological trend, its clinical presentation, management and prognosis.
This presentation focuses on common obstetrics emergencies. These include early pregnancy complications such as miscarriages and ectopic pregnancy. As well as abdominal pain. Other include haemorrhage, hypertensive state, and sepsis.
This presentation addresses respiratory emergencies, and the approach to their management. These include: anaphylaxis, pneumonias, flail chest, pleural effusion, pulmonary embolism,
This presentation focuses on informed decision making in clinical practice making use of evidence based practice. It addresses the use of PICO to formulate clinical question, searching the evidence/literature, critically appraising the evidence, and application of the evidence to improve the quality of clinical practice
Multiple myeloma is mostly a disease of the elderly. It is a form of haematological cancers that affects the Lymphocytes, and causes abnormal proliferation of plasma cells within the bone marrow, thus replacing the marrow, and is associated with multiple organ dysfunction.
This presentation is an introduction to the disease. It however leaves out the specific haematological treatment, because by that point, patient should have been referred to haematology.
Spinal Cord Injuries are uncommon, but they are a leading cause of high cost disability, and with ageing population, the incidence is expected to increase. This presentation looks at the many facets of spinal cord injuries.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
Chronic Obstructive Pulmonary Disease (COPD) by Dr Kemi Dele
1. C O P D
CHRONIC OBSTRUCTIVE LUNG
DISEASE
PRESENTED BY DR KD DELE
DEPARTMENT OF FAMILY MEDICINE; DORA NGINZA HOSPITAL
2. CONTENT
• Definition and Overview
• Diagnosis and Assessment
• Therapeutic Options
• Management of Exacerbations
• Management of Stable COPD
• Management of Comorbidities
• Slides On Pathophysiology Of COPD
4. Definition of COPD
• COPD, a common preventable and treatable disease, is
characterized by persistent airflow limitation that is usually
progressive and associated with an enhanced chronic
inflammatory response in the airways and the lung to
noxious particles or gases.
• Exacerbations and comorbidities contribute to the overall
severity in individual patients.
6. Burden of COPD
• COPD is a leading cause of morbidity and mortality worldwide.
• 30% of smokers develop COPD
• 20% of adult males have COPD
• 15% of COPD patients are severely symptomatic
• 4th leading cause of death (USA)
• Mortality rate still rising
• High prevalence in low birth weight and low socioeconomic status
• Tuberculosis in smokers predisposes to COPD
• COPD is associated with significant economic burden.
7. Risk Factors for COPD
• Genes
• Exposure to particles
• Tobacco smoke
• Occupational dusts, organic and inorganic
• Indoor air pollution from heating and cooking with biomass in poorly
ventilated dwellings
• Outdoor air pollution
8. Risk Factors for COPD cont.
• Lung growth and development
• Gender
• Age
• Respiratory infections
• Socioeconomic status
• Asthma/Bronchial hyperreactivity
• Chronic Bronchitis
9. Risk Factors for COPD cont.
Aging Populations
Genes
Infections
Socio-economic
status
11. Diagnosis and Assessment
• A clinical diagnosis of COPD:
• any patient who has dyspnoea, chronic cough or sputum production,
• and a history of exposure to risk factors for the disease.
• to make the diagnosis;
• Spirometry is required
• the presence of a post-bronchodilator FEV1/FVC < 0.70 confirms the
presence of persistent airflow limitation and thus of COPD.
12. Diagnosis and Assessment, cont.
• The goals of COPD assessment
• to determine
• the severity of the disease,
• the severity of airflow limitation,
• the impact on the patient’s health status,
• and the risk of future events.
• Comorbidities
• They occur frequently in COPD patients
• They should be actively looked for and treated appropriately if present.
14. Spirometry:
Assessment of Airflow Limitation
• Spirometry should be performed after the administration of an
adequate dose of a short-acting inhaled bronchodilator to minimize
variability.
• A post-bronchodilator FEV1/FVC < 0.70 confirms the presence of
airflow limitation.
• Where possible, values should be compared to age-related normal
values to avoid over-diagnosis of COPD in the elderly.
22. Assessment of COPD: Goals
• Determine the severity of the disease, its impact on the patient’s health
status and the risk of future events (for example exacerbations) to guide
therapy.
• Consider the following aspects of the disease separately:
• current level of patient’s symptoms
• severity of the spirometric abnormality
• frequency of exacerbations
• presence of comorbidities.
23. ASSESSMENT OF COPD
• Assess symptoms
• Assess degree of airflow limitation using spirometry
• Assess risk of exacerbations
• Assess comorbidities
• Combine these assessments (first three) for the purpose of improving
management of COPD
24. 1. Assess Symptoms of COPD
• The characteristic symptoms of COPD are chronic and progressive
dyspnoea, cough, and sputum production that can be variable from
day-to-day.
• Dyspnoea: Progressive, persistent and characteristically worse with
exercise.
• Chronic cough: May be intermittent and may be unproductive.
• Chronic sputum production: COPD patients commonly cough up
sputum.
• Others include:Wheezing; Cyanosis; Right heart failure; Weight loss,
anorexia
25. Need For Simple Tools
• Significant numbers of patients have COPD that is under-recognised,
untreated and sub-optimally managed, despite widening use of spirometry
• Patients underestimate their condition: in a study1 (n=3265),
• 36% of those too breathless to leave the house described their condition as mild or
moderate; and
• 60% of those who were short of breath after walking for a few minutes on the flat
described their condition as mild or moderate
• Studies also confirm that patients and physicians require a tool to
• facilitate fact-based dialogue
• to help achieve a mutual understanding of disease status and impact; and
• to help to optimise disease management
26. Assess Symptoms of COPD, cont.
COPD Assessment Test (CAT):
• An 8-item measure of health status impairment in COPD
(http://catestonline.org).
Clinical COPD Questionnaire (CCQ):
• Self-administered questionnaire developed to measure clinical control in
patients with COPD (http://www.ccq.nl).
Breathlessness Measurement using the Modified British Medical Research
Council (mMRC) Questionnaire
• relates well to other measures of health status and predicts future mortality
risk.
27. Assess Symptoms of COPD, cont.
• The CAT has been designed to overcome the shortfalls of earlier
questionnaires measuring disability in COPD.
• The CAT is a simple, short, easy to use self-administered, paper-based
questionnaire for use in clinical practice.
• The MRC dyspnoea questionnaire measures dyspnoea only whereas
CAT is a holistic measure of the impact of COPD on the patient
31. Differences between COPD questionnaires
SGRQ MRC Dyspnoea
Questionnaire
CCQ CAT
• Measures impaired
health and wellbeing
• Measures dyspnoea
only
• Measures clinical
disease control
• Measures holistic
impact of COPD on
patients
• Used largely in clinical
trials
– • Used in clinical
practice
• Used in clinical
practice
• Long (76-items) • Short (5-items) • Short (10-items) • Short (8 items)
• Patient completed • Patient completed • Patient completed • Patient completed
• Computer required • Paper based • Paper based • Paper based
• Complex to administer • Simple to administer • Simple to administer • Simple to administer
32. 2. Assess degree of airflow limitation
• Use spirometry for grading severity
• according to spirometry,
• using four grades split at 80%, 50% and 30% of predicted value
•
34. 3. Assess Risk of Exacerbations
• To assess risk of exacerbations:
• Use history of exacerbations and spirometry.
• Two exacerbations or more within the last year or
• an FEV1 < 50 % of predicted value
are indicators of high risk.
• Hospitalization for a COPD exacerbation associated with
increased risk of death.
35. Combined Assessment Of COPD
• Assess symptoms
• Assess degree of airflow limitation using spirometry
• Assess risk of exacerbations
• Combine these assessments for the purpose of improving management
of COPD
40. 4. Assess COPD Comorbidities
• COPD patients are at increased risk for:
• Cardiovascular diseases
• Osteoporosis
• Respiratory infections
• Anxiety and Depression
• Diabetes
• Lung cancer
• Bronchiectasis
• These comorbid conditions may influence mortality and hospitalizations and
should be looked for routinely, and treated appropriately
44. COPD and Asthma
COPD
• Onset in mid-life
• Symptoms slowly progressive
• Long smoking history
Asthma
• Onset early in life (often childhood)
• Symptoms vary from day to day
• Symptoms worse at night/early morning
• Allergy, rhinitis, and/or eczema also
present
• Family history of asthma
48. Additional Investigations
Chest X-ray:
• Seldom diagnostic but valuable to exclude alternative diagnoses and establish
presence of significant comorbidities.
Lung Volumes and Diffusing Capacity:
• Help to characterize severity, but not essential to patient management.
Oximetry and Arterial Blood Gases:
• Pulse oximetry can be used to evaluate a patient’s oxygen saturation and need for
supplemental oxygen therapy.
49. Additional Investigations
Alpha-1 Antitrypsin Deficiency Screening:
• Perform when COPD develops in patients of Caucasian descent under 45 years or with a strong
family history of COPD.
Exercise Testing:
• Objectively measured exercise impairment, assessed by a reduction in self-paced walking
distance (such as the 6 min walking test) or during incremental exercise testing in a laboratory,
is a powerful indicator of health status impairment and predictor of prognosis.
Composite Scores:
• Several variables (FEV1, exercise tolerance assessed by walking distance or peak oxygen
consumption, weight loss and reduction in the arterial oxygen tension) identify patients at
increased risk for mortality.
51. Therapeutic Options
• Smoking cessation has the greatest capacity to influence the natural history of COPD.
Encourage all patients who smoke to quit.
• Pharmacotherapy and nicotine replacement increase long-term smoking abstinence rates.
• All COPD patients benefit from regular physical activity – encouraged to remain active.
• Appropriate pharmacologic therapy can reduce COPD symptoms, reduce the frequency
and severity of exacerbations, and improve health status and exercise tolerance.
• None of the existing medications for COPD has been shown conclusively to modify the
long-term decline in lung function.
• Influenza and pneumococcal vaccination should be offered per local guidelines.
52. Quit Smoking: Strategies
• ASK Systematically identify all tobacco users at every visit
• ADVISE Strongly urge all tobacco users to quit
• ASSESS Determine willingness to make a quit attempt
• ASSIST Aid the patient in quitting eg nicotine replacement
• ARRANGE Schedule follow-up
53. Therapeutic Options: Risk Reduction
Tobacco-control:
• clear, consistent, and repeated non-smoking messages.
Primary prevention:
• elimination or reduction of exposures in the workplace.
Secondary prevention:
• surveillance and early detection.
Others
• Reduce or avoid indoor air pollution from biomass fuel, burned for cooking and
heating in poorly ventilated dwellings.
• monitor public announcements of air quality and, depending on the severity of
their disease, avoid vigorous exercise outdoors or stay indoors during pollution
episodes.
58. Therapeutic Options: Bronchodilators
• Bronchodilator medications are central to the symptomatic management of
COPD.
• Bronchodilators are prescribed on an as-needed or on a regular basis to
prevent or reduce symptoms.
• The principal bronchodilator treatments are
• beta2-agonists
• anticholinergics
• theophylline or
• combination therapy.
59. Therapeutic Options: Bronchodilators cont.
• The choice of treatment depends on: availability of medications and each
patient’s response in terms of symptom relief and side effects.
Long-acting inhaled bronchodilators:
• are convenient and more effective for symptom relief than short-acting
bronchodilators.
• reduce exacerbations and related hospitalizations and improve symptoms
and health status.
Combining bronchodilators of different pharmacological classes:
• may improve efficacy and decrease the risk of side effects compared to
increasing the dose of a single bronchodilator.
60. Therapeutic Options: Inhaled Corticosteroids
• Regular treatment with inhaled corticosteroids improves symptoms, lung
function and quality of life and reduces frequency of exacerbations for COPD
patients with an FEV1 < 60% predicted.
• Inhaled corticosteroid therapy is associated with an increased risk of
pneumonia.
• Withdrawal from treatment with inhaled corticosteroids may lead to
exacerbations in some patients.
61. Therapeutic Options: Combination Therapy
• An inhaled corticosteroid combined with a long-acting beta2-agonist is
more effective than the individual components in improving lung function
and health status and reducing exacerbations in moderate to very severe
COPD.
• Addition of a long-acting beta2-agonist/inhaled glucorticosteroid
combination to an anticholinergic (tiotropium) appears to provide
additional benefits.
• Combination therapy is associated with an increased risk of pneumonia.
62. Therapeutic Options cont.
Phosphodiesterase-4 Inhibitors
• In patients with severe and very severe COPD (GOLD 3 and 4) and a history
of exacerbations and chronic bronchitis, the phospodiesterase-4 inhibitor,
roflumilast, reduces exacerbations treated with oral glucocorticosteroids.
Systemic Corticosteroids
• Chronic treatment with systemic corticosteroids should be AVOIDED because
of an unfavourable benefit-to-risk ratio.
63. Therapeutic Options: Theophylline
• Low dose theophylline reduces exacerbations but does not improve post-
bronchodilator lung function.
• Theophylline is less effective and less well tolerated than inhaled long-acting
bronchodilators (not recommended if those drugs are available and
affordable).
• Theophylline has a modest bronchodilator effect and some symptomatic
benefit in stable COPD.
• Addition of theophylline to salmeterol (laba) produces a greater increase in
FEV1 and breathlessness than salmeterol alone.
64. Therapeutic Options: Other Pharmacologic
Treatments
Influenza vaccines:
• it can reduce serious illness. Pneumococcal polysaccharide vaccine is recommended for COPD
patients 65 years and older and for COPD patients younger than age 65 with an FEV1 < 40%
predicted.
Antibiotics:
• The use of antibiotics, other than for treating infectious exacerbations of COPD and other
bacterial infections, is currently not indicated.
Alpha-1 antitrypsin augmentation therapy:
• not recommended for patients with COPD that is unrelated to the genetic deficiency.
65. Therapeutic Options: Other Pharmacologic
Treatments cont.
Mucolytics:
• Patients with viscous sputum may benefit from mucolytics; overall benefits are very small.
Antitussives:
• Not recommended.
Vasodilators:
• Nitric oxide is contraindicated in stable COPD. The use of endothelium-modulating agents
for the treatment of pulmonary hypertension associated with COPD is not recommended
66. Therapeutic Options: Surgical Treatments
Bullectomy
• Resection of large bullae compressing normal lung
Lung volume reduction surgery (LVRS)
• LVRS is more efficacious than medical therapy among patients with upper-lobe predominant
emphysema and low exercise capacity.
• LVRS is costly relative to health-care programs not including surgery.
Double lung transplantation
• For patients with very severe COPD,
• It improves quality of life and functional capacity.
• It is costly, can be lack of donor availability and requires lifelong immunosuppression.
67. Therapeutic Options: Other Treatments
Pulmonary Rehabilitation:
• Aimed at keeping patient conditioned with exercise, perception of dyspnea, quality
of life and self-efficacy.
Oxygen Therapy:
• The long-term administration of oxygen (> 15 hours per day) to patients with chronic respiratory
failure increases survival in patients with severe, resting hypoxemia.
Ventilatory Support:
• Combination of non-invasive ventilation (NIV) with long-term oxygen therapy may be of some
use in patients with pronounced daytime hypercapnia.
Palliative Care, End-of-life Care, Hospice Care:
• Communication with advanced COPD patients about end-of-life care and advance care planning
gives patients and their families the opportunity to make informed decisions.
69. COPD EXACERBATION
• An exacerbation of COPD is:
• “an acute event characterized by a worsening of the patient’s
respiratory symptoms that is beyond normal day-to-day variations and
leads to a change in medication.”
• The goal of treatment is to minimize the impact of the current
exacerbation and to prevent the development of subsequent
exacerbations.
70. COPD EXACERBATION cont.
The most common causes of COPD exacerbations:
• viral upper respiratory tract infections and
• infection of the tracheobronchial tree.
Diagnosis
• relies exclusively on the clinical presentation of the patient complaining of an acute change of
symptoms that is beyond normal day-to-day variation.
• COPD exacerbations can often be prevented.
71. Immediate management.
• Assess severity of attack.
• Start treatment prior to investigations.
• Sit up and give oxygen e.g. 60%.
• Salbutamol 5mg in saline nebulization.
• Hydrocortisone 200mg IV or 30mg predisone per os.
• If life threatening add ipratropium 0.5mg to beta 2 stimulant as
nebulization
• MgSO4 2g in 200ml N saline over 20 minutes
• Intubate and Ventilate
• If still not improving consider ICU.
72. Manage Exacerbations: Assessments
• Arterial blood gas measurements (in hospital):
• PaO2 < 8.0 kPa with or without PaCO2 > 6.7 kPa when breathing room air
indicates respiratory failure.
• Chest radiographs:
• useful to exclude alternative diagnoses.
• ECG:
• may aid in the diagnosis of coexisting cardiac problems.
• Whole blood count:
• identify polycythaemia, anaemia or bleeding.
73. Manage Exacerbations: Assessments
• Purulent sputum during an exacerbation:
• indication to begin empirical antibiotic treatment.
• Biochemical tests:
• detect electrolyte disturbances, diabetes, and poor nutrition.
• Spirometric tests:
• not recommended during an exacerbation.
74. Manage Exacerbations: Treatment
options
Oxygen:
• titrate to improve the patient’s hypoxemia with a target saturation of 88-92%.
Bronchodilators:
• short-acting inhaled beta2-agonists with or without short-acting anticholinergics are
usually the preferred bronchodilators for treatment of an exacerbation.
Systemic Corticosteroids:
• shortens recovery time,
• improves lung function (FEV1) and arterial hypoxemia (PaO2),
• reduce the risk of early relapse, treatment failure, and length of hospital stay.
• dose of 40 mg prednisone per day for 5 days.
75. Manage Exacerbations: Treatment
Options cont.
Antibiotics:
• should be given to
• patients with three cardinal symptoms: increased dyspnoea, increased sputum volume, and
increased sputum purulence.
• Patients who require mechanical ventilation.
• It reduces the risk of early relapse, treatment failure, and length of hospital stay
Non-invasive ventilation (NIV):
• For patients hospitalized for acute exacerbations of COPD:
• Improves respiratory acidosis, decreases respiratory rate, severity of dyspnoea,
complications and length of hospital stay.
• Decreases mortality and needs for intubation.
76. Indications for hospital admission
• Marked increase in intensity of symptoms
• Severe underlying COPD
• Onset of new physical signs
• Failure of an exacerbation to respond to initial medical management
• Presence of serious comorbidities
• Frequent exacerbations
• Older age
• Insufficient home support
79. Manage Stable COPD: Overview
• Identification and reduction of exposure to risk factors
• Individualized assessment of symptoms, airflow limitation, and future
risk of exacerbations
• All COPD patients benefit from rehabilitation and maintenance of
physical activity.
• Pharmacologic therapy is used to
• reduce symptoms,
• reduce frequency and severity of exacerbations, and
• improve health status and exercise tolerance.
• Influenza vaccination
87. Manage Comorbidities
• COPD often coexists with other diseases (comorbidities) that may have
a significant impact on prognosis. In general, presence of comorbidities
should not alter COPD treatment and comorbidities should be treated
as if the patient did not have COPD.
88. Manage Comorbidities cont.
• Osteoporosis and anxiety/depression:
• often under-diagnosed and associated with poor health status and prognosis.
• Lung cancer:
• frequent in patients with COPD; the most frequent cause of death in patients with mild COPD.
• Serious infections:
• respiratory infections are especially frequent.
• Metabolic syndrome and manifest diabetes:
• more frequent in COPD and the latter is likely to impact on prognosis.
• Cardiovascular disease (ischemic heart disease, heart failure, atrial fibrillation &
hypertension)
• most frequent and most important disease coexisting with COPD.
• Benefits of cardioselective beta-blocker treatment in heart failure may outweigh potential risk.